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Tenosynovial fluid as an indication of early posterior tibial tendon dysfunction in patients with normal tendon appearance

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Abstract

Objective

Our primary aim was to quantify the posterior tibial tendon (PTT) sheath fluid volume in individuals with the clinical diagnosis of stage 1 posterior tibial tendon dysfunction (PTTD) and no MRI-detectable intra-substance tendon pathology and compare them with patients with other causes of medial ankle pain, also without MRI-detectable intra-substance PTT pathology and with normal controls. We also wanted to determine if there is a fluid measurement that correlates with the clinical diagnosis of PTTD.

Materials and Methods

A total of 326 individuals with medial ankle pain and no intra-substance PTT pathology were studied. Group 1 included 48 patients with a clinical diagnosis of stage 1 PTT dysfunction, group 2 comprised 278 patients with other causes of medial ankle pain, and a third control group consisted of 56 patients without any medial ankle pain. MRI-based geometric measurements included PTT fluid volume, maximum cross-sectional fluid area, and fluid width. Fluid measurements were compared between groups and measurement reliability was tested.

Results

Group 1 showed greater PTT fluid volume, area, and width compared with groups 2 (other causes of medial ankle pain) and 3 (asymptomatic controls) (all p values < 0.001). A 9-mm threshold maximum fluid width was associated with PTTD (sensitivity 84%, specificity 85%). Measurements were reliable (all p values < 0.03) among three observers blinded to the gold standard.

Conclusion

Patients with stage 1 PTT dysfunction displayed greater volumes of tendon-sheath fluid than those with other causes of medial ankle pain and compared with asymptomatic controls. A threshold maximum fluid width greater than or equal to 9 mm distinguishes those with PTTD. An association between tendon sheath fluid distension and the clinical diagnosis of stage 1 posterior tibial tendon disease in the setting of no MRI-detectable intra-substance tendon pathology may allow for differentiation of medial ankle pain from other sources and may allow for early intervention aimed at preventing progressive PTTD. The level of evidence was prognostic (level III).

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA

    Felix M. Gonzalez, Elie Harmouche, Douglas D. Robertson, Monica Umpierrez, Adam D. Singer & Yara Younan

  2. Emory University Orthopaedic and Spine Center, 59 Executive Park S, Suite 2000, Atlanta, GA, 30329, USA

    Jason Bariteau

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  1. Felix M. Gonzalez
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  2. Elie Harmouche
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  3. Douglas D. Robertson
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Correspondence to Felix M. Gonzalez.

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This retrospective study was approved by the institution’s ethics committee. All authors made substantial contributions to conception and design, and/or acquisition of data, and/or analysis and interpretation of data. Authors also participated in drafting the article and revising it critically for important intellectual content; and the authors gave final approval of the version to be submitted and any revised version.

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Gonzalez, F.M., Harmouche, E., Robertson, D.D. et al. Tenosynovial fluid as an indication of early posterior tibial tendon dysfunction in patients with normal tendon appearance. Skeletal Radiol 48, 1377–1383 (2019). https://doi.org/10.1007/s00256-018-3142-y

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  • DOI: https://doi.org/10.1007/s00256-018-3142-y

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